「112-2 (三) 7」ACS 的藥物治療

Georgie

建立於 2024年05月18日

: ACS 的藥物治療 (B) 鈣離子阻斷劑（calciumchannelblocker）可以擴張冠狀動脈、增加心肌供血，因此短效型dihydropyridine(non-dihydropyridine CCB) 類鈣離子阻斷劑特別適用於無法耐受乙型交感神經阻斷劑（betablocker）副作用的病人 1. 無法耐受乙型交感神經阻斷劑（beta blocker）副作用的病人可以使用 non-dihydropyridine CCB.  The ACC/AHA UA/NSTEMI guidelines recommend that for patients with continuing or frequent ischemia in whom a beta-blocker cannot be given a non-dihydropyridine CCB should be administered (COR I, LOE B) in the absence of clinically significant LV dysfunction or other contraindications. *The non-DHP CCBs including diltiazem and verapamil.  2. 為什麼不能使用短效型dihydropyridine？ 有什麼狀況下可以使用嗎？  Short-acting dihydropyridines such as the non-sustained release form of nifedipine must not be given to patients with ACS in the absence of beta-blocker therapy because of the associated deleterious risk of reflex tachycardia. The guidelines emphasize that immediate-release dihydropyridine CCBs should not be administered to patients with UA/NSTEMI in the absence of a beta-blocker (COR III, LOE A). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4083844/ (C) 阿斯匹靈（aspirin）為可逆性(不可逆)血小板cyclooxygenase抑制劑，減低血小板活化能力，冠狀動脈心臟病人常用劑量為每日75～325mg Aspirin 75~325mg daily dosage come from Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial, 12 562 patients with ACS using aspirin, 75 to 325 mg daily.  https://www.ahajournals.org/doi/10.1161/01.cir.0000091201.39590.cb 根據 guideline, loading dose 162-325mg, maintainence dose 81-325mg/day. (可參考下圖)   (D) 有機硝酸鹽類（nitrate）經人體代謝後，可釋放一氧化氮（NO）與血管平滑肌adenylylcyclase (guanlylcyclase) 結合，造成血管擴張